Dr. Sumeet J. Bhushan

Specialist in Gastroenterology

A LITTLE ABOUT ME

Here at Galen Digestive Health – Downtown our providers focus on the evaluation and treatment of disorders of the gastrointestinal tract. Our gastroenterologists have an extensive understanding of the entire gastrointestinal tract, including the esophagus, stomach, small intestine, liver, gall bladder, pancreas, colon, and rectum.

Our providers are experts in how gastrointestinal disorders affect other organs and manifest themselves clinically. We treat patients throughout the greater Chattanooga area and operate an accredited endoscopy center where most of our outpatient procedures are performed. Our practice is comprised of a diverse group of physicians and our office is conveniently located on East Third Street, in downtown Chattanooga.

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For this test, the doctor looks at the entire length of the colon and rectum with a colonoscope, a flexible tube about the width of a finger with a light and small video camera on the end. It’s put in through the anus and into the rectum and colon. Special instruments can be passed through the colonoscope to biopsy (sample) or remove any suspicious-looking areas such as polyps, if needed.

Before the test: Be sure your doctor knows about any medicines you are taking (including daily aspirin, vitamins, or supplements). You might need to change how you take them before the test.

The colon and rectum must be empty and clean so your doctor can see the entire inner lining during the test. There are different ways to do this, including pills, fluids, and enemas (or combinations of these). For example, you might need to drink large amounts of a liquid laxative solution the evening before the procedure. This often results in spending a lot of time in the bathroom. Because the process of cleaning out the colon and rectum is sometimes unpleasant, it can keep some people from getting this test done. However, newer kits are available to clean out the bowel and may be better tolerated than previous ones. Your health care provider can discuss the options with you.

Your health care provider will give you specific instructions. It’s important to read them carefully a few days ahead of time, since you may need to follow a special diet for at least a day before the test and to shop for supplies and laxatives. If you’re not sure about any of the instructions, call the health care provider’s office and get your questions answered.

You will probably also be told not to eat or drink anything after a certain hour the night before your test. If you normally take prescription medicines in the mornings, talk with your doctor or nurse about how to manage them for that day.

Because a sedative is used to help keep you more comfortable during the test, you will most likely need to arrange for someone you know to take you home after the test. You might need someone to help you get into your home if you are sleepy or dizzy, so many centers that do colonoscopies will not discharge people to go home in a cab or a ridesharing service. If transportation might be a problem, talk with your health care provider about the policy at your hospital or surgery center for using one of these services. There may be other resources available for getting home, depending on the situation.

During the test: The test itself usually takes about 30 minutes, but it may take longer if one or more polyps is found and removed. Before the test starts, you’ll likely be given a sedative (into a vein) to make you feel relaxed and sleepy during the procedure. For most people, this medicine makes them unable to remember the procedure afterward. You’ll wake up after the test is over, but you might not be fully awake until later in the day.

During the test, you’ll be asked to lie on your side with your knees pulled up. A drape will cover you. Your blood pressure, heart rate, and breathing rate will be monitored during and after the test.

Your doctor might insert a gloved finger into the rectum to examine it before putting in the colonoscope. The colonoscope is lubricated so it can be inserted easily into the rectum. Once in the rectum, the colonoscope is passed all the way to the beginning of the colon, called the cecum.

If you’re awake, you may feel an urge to have a bowel movement when the colonoscope is inserted or pushed further up the colon. The doctor also puts air into the colon through the colonoscope to make it easier to see the lining of the colon and use the instruments to perform the test. To ease any discomfort, it may help to breathe deeply and slowly through your mouth.

The doctor will look at the inner walls of the colon as he or she slowly removes the colonoscope. If a small polyp is found, it may be removed and then sent to a lab to check if it has any areas that have changed into cancer. This is because some small polyps may become cancer over time.

If your doctor sees a larger polyp or tumor, or anything else abnormal, a small piece of it will be removed (biopsied) through the colonoscope. It will be checked in the lab to see if it’s cancer, a benign (non-cancerous) growth, or something else.

Possible side effects and complications: The bowel preparation before the test can be unpleasant.

The test itself might be uncomfortable, but the sedative usually helps with this, and most people feel back to normal once the effects of the sedative wear off. Because air is pumped into the colon and rectum during the test, people sometimes feel bloated, have gas pains, or have cramping for a while after the test until the air passes out.

Some people may have low blood pressure or changes in heart rhythm from the sedation during the test, but these are rarely serious.

If a polyp is removed or a biopsy is done during the colonoscopy, you might notice some blood in your stool for a day or 2 after the test. Serious bleeding is uncommon, but in rare cases, bleeding might need to be treated or can even be life-threatening.

Colonoscopy is a safe procedure, but in rare cases the colonoscope can puncture the wall of the colon or rectum. This is called a perforation. Symptoms can include severe abdominal (belly) pain, nausea, and vomiting. This can be a major (or even life-threatening) complication, because it can lead to a serious abdominal (belly) infection. The hole may need to be repaired with surgery. Ask your doctor about the risk of this complication.

Endoscopy is a medical procedure where a doctor puts a tube-like instrument into the body to look inside. There are many types of endoscopy, each of which is designed for looking at a certain part of the body. Here we provide a brief overview of the most common types of endoscopy, including what they are used for and what to expect when you have them.

What is an endoscopy? Endoscopy (en-DAHS-kuh-pee) is a medical procedure done with an instrument called an endoscope (EN-duh-skop). The endoscope is put into the body to look inside, and is sometimes used for certain kinds of surgery.

Looking with an endoscope is different from using imaging tests, like x-rays and CT scans, which can get pictures of the inside the body without putting tools or devices into it.

There are many different kinds of endoscopes, or “scopes.” Most are like thin, hollow tubes that a doctor uses to look right into the body. Most are lighted, and some have a small video camera on the end that puts pictures on a computer screen. Endoscopes are different lengths and shapes. Some are stiff, while others are flexible. There’s a new one small enough to be swallowed, which can send images wirelessly. Each type is specially designed for looking at a certain part of the body.

Depending on the area of the body being looked at, the endoscope may be put in the mouth, anus, or urethra (your-EE-thruh) (the tube that carries urine out of the bladder). Sometimes, it’s put through a small incision (cut) made in the skin.

What is an endoscopy procedure like? There are many different types of endoscopy procedures, and the experience of having one can vary a lot from one type to the next. It’s important to keep in mind that some procedures might be done in more than one way. For example, bronchoscopy and laryngoscopy can be done with either a flexible or rigid scope. Local anesthesia (numbing the area) is generally used for flexible scopes, while rigid scopes often require general anesthesia (where you are given drugs to put you into a deep sleep).

People’s experiences may also vary depending on their health and what needs to be done, such as whether biopsy samples are going to be taken.

If you are going to have an endoscopy, your health care team will explain to you what will be done and what to expect before, during, and after the test. They will also tell you what you need to do to prepare for the procedure. The preparation could mean that you must fast (not eat anything) for a certain amount of time, follow a liquid diet for a certain amount of time, and/or use laxatives or enemas.

During this test, the doctor looks at part of the colon and rectum with a sigmoidoscope (a flexible, lighted tube about the thickness of a finger with a small video camera on the end). It’s put in through the anus and into the rectum and moved into the lower part of the colon. Images from the scope are seen on a video screen.

Using the sigmoidoscope, your doctor can look at the inside of the rectum and part of the colon to detect (and possibly remove) any abnormalities. The sigmoidoscope is only about 60 centimeters (about 2 feet) long, so the doctor can see the entire rectum but less than half of the colon with this procedure.

This test is not widely used as a screening test for colorectal cancer in the United States.

Before the test: Be sure your doctor knows about any medicines you take. You might need to change how you take them before the test.

Your insides must be empty and clean so your doctor can see the lining of the sigmoid colon and rectum. You will get specific instructions to follow to clean them out. You may be asked to follow a special diet (such as drinking only clear liquids) or to use enemas or strong laxatives the day before the test to clean out your colon and rectum.

During the test: A sigmoidoscopy usually takes about 10 to 20 minutes. Most people don’t need to be sedated for this test, but this might be an option you can discuss with your doctor. Sedation may make the test less uncomfortable, but you’ll need some time to recover from it and you’ll need someone with you to take you home after the test.

You’ll probably be asked to lie on a table on your left side with your knees pulled up near your chest. Before the test, your doctor may put a gloved, lubricated finger into your rectum to examine it. For the test itself, the sigmoidoscope is first lubricated to make it easier to insert into the rectum. The scope may feel cold as it’s put in. Air will be pumped into the colon and rectum through the sigmoidoscope so the doctor can see the inner lining better.

If you are not sedated during the procedure, you might feel pressure and slight cramping in your lower belly. To ease discomfort and the urge to have a bowel movement, it may help to breathe deeply and slowly through your mouth. You’ll feel better after the test once the air leaves your colon.

If any polyps are found during the test, the doctor may remove them with a small instrument passed through the scope. The polyps will be looked at in the lab. If a pre-cancerous polyp (an adenoma) or colorectal cancer is found, you’ll need to have a colonoscopy later to look for polyps or cancer in the rest of the colon.

Possible complications and side effects: This test may be uncomfortable because of the air put into the colon and rectum, but it should not be painful. Be sure to let your doctor know if you feel pain during the procedure. You might see a small amount of blood in your bowel movements for a day or 2 after the test. More serious bleeding and puncture of the colon or rectum are possible complications, but they are very uncommon.